When Your 35-Year-Old Patient has a Sternotomy Scar: Anesthesia for Adult Patients with Congenital Heart Disease Presenting for Noncardiac Surgery

Patients with CHD who present for noncardiac surgery are a particular challenge for anesthesiologists. They represent a complex and wide variety of pathologies, each of which has required a different surgical palliation or correction. The concomitant comorbidities present in the population further complicate the picture. An anesthesiologist's knowledge of the ACHD patient will allow him/her to serve as the leader of the perioperative team when making care decisions both within and outside the operating room. Therefore, anesthesiologists responsible for the care of ACHD patients undergoing noncardiac surgery must make a thorough understanding of the patient's unique physiology and hemodynamics their first priority. He/she must consider each step of the patient's care throughout the perioperative period. As discussed earlier, patients with CHD are best treated in tertiary care centers wheremultidisciplinary expertise is available. In emergent situations, however, the patient may not have immediate access to such a center. Alternatively, the patient may prefer another location, further emphasizing the need for basic knowledge across the anesthesiology discipline.